214880 11/20/2012 CITY OF CARMEL, INDIANA VENDOR: 366022 Page 1 of 1
ONE CIVIC SQUARE XYLEM DEWATERING SOLUTIONS INC CHECK AMOUNT: $1,057.04
�' ?o CARMEL, INDIANA 46032 PO BOX 935152
ATLANTA GA 31193-5152 CHECK NUMBER: 214880
CHECK DATE: 11/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 07710734 156 .42 OTHER EXPENSES
651 5023990 400263632 900 . 62 OTHER EXPENSES
Xylem Water Solutions U.S.A., Inc.
7615 W. NEW YORK STREET
INDIANAPOLIS,IN 46214 INVOICE YOUR PURCHASE ORDER
Tel.(317)273-4470 Fax:(317)273-4480 I S13364
INVOICE NO. FUS NO. DATE SHIPPED I DELIVERY NOTE
P.O. BOX 223724 07710734 871935 10/31/121 A45328
Pittsburgh, PA 15251-2724 INVOICE DATE FA RN WHS PAYMENT TERMS
10/31/12 3 115 NET 60 DAYS
Sold To: Customer No. 10 3 9 7 3 Ship To:
CITY OF CARMEL CITY OF CARMEL INDIANA
ATTN: LISA KEMPER PO #513364
760 THIRD AVE SW 9609 HAZEL DELL PARKWAY
INDIANAPOLIS IN 46280
CARMEL IN 46032
INCO TERMS DELIVERY TERMS ORDER PROCESSED BY
CA US WH/ Factory PP/Add Actual surcha FLYGT-INDIANAPOLIS,IN BRA
SHIP VIA ORDER TEXT CUSTOMER TEXT _.
UPS-Ground JEFF COOPER ED RYAN
LINE ITEM/DESCRfPTION QUANTITY SHIPPED UNIT PRICE NET PRICE EXTENDED AMOUNT
UM DISCOUNT/CHARGE
001 0000000827390 50 1 . 40 1 . 400 70 . 00
O-RING 19 . 2 X 3 . 0 NBR EA
002 0000000827730 20 4 . 00 4 . 000 80 . 00
O-RING 28 . 17 X 3 . 53 NBR EA
SUB-TOTAL OF POSITIONS USD 150 . 00
*PLUS ACTUAL FREIGHT CHARGES* 6 . 42
TOTAL WEIGHT 1 . 000 LBS
NET AMOUNT BEFORE TAXES ' USD 156 . 42
DISPATCH INFO: 1Z4F398X0340859515
ORDER TOTAL USD
156 . 42
Invoice
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�m/dby; Branch 037 Remit to: Xylem Dewatohng S
o utinno. Inc.
7815VNYStreet P.O. Box 935152
Indianapolis, |N46214 Atlanta, GA31193'5152
�y Let's Solve Water Tel: 317-217-5131 Phone: 856-467-3636
Fax: 317-273-4480
g[]dVV'ne
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D City ofCarmel H City ofCarmel
L Attn: Carmel Utilities | Attn: Carmel Utilities 00003181 11-02-2012 400263632
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One C��Square 9609 Hazel Dell Parkway Page 1Of1
T Carmel IN 46032 T Indianapolis, IN 46280
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plipt
S13341 Mr. Jeff Cooper 10-12-2012 11-02-2012 237000276 Mark Lefkowicz Jason Hall Net 30
DESCRIPTION' 6RDERED SHIPPED Bl&d ,,PRICE PRICE'- SELL'
2305682016 Ejector Jet 1 1 0 175.75 175.75 175.75
2305702011 CD Ejector Collar 1 1 0 108.75 108.75 108.75
2302431213 CD 100 Poly IN RV Seat 1 1 0 48.50 48.50 48.50
3810144112A Ejector Nozzle O-Ring 1 1 0 1.52 1.52 1.52
INBOUNDFRT037 Inbound Freight Delivery Br 037 1 1 0 110.00 110.00 110.00
ALL PAST DUE INVOICES ARE SUBJECT TO
1 1/2% PER MONTH SERVICE CHAKUt
Total Invoice $ 900.62
VOUCHER # 126106 WARRANT # ALLOWED
352772 IN SUM OF $
Xylem Water Solutions USA Inc (GODW
PO box 223724
Pittsburgh, PA 15251-2724
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
400263632 01-7202-06 $900.62
O'7-710"73y 01`7,20A 156.` J
i
1
I
05
Voucher Total X66 62�
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No.201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
352772
Xylem Water Solutions USA Inc(GODWIN PUMF Purchase Order No.
PO box 223724 Terms
Pittsburgh, PA 15251-2724 Due Date 11/13/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/13/201; 400263632 $900.62
hereby certify that the attached invoice(s), or bill(s) is (are) true and
,orrect and I have audited same in accordance with IC>5-11-10-1.6
Date Officer